Assignment task:
In what ways has J.S.'s medical condition contributed to her psychological functioning and difficulties? Detail a biopsychosocial-oriented treatment plan for Mrs. S. that addresses her medical and psychological symptoms at a biological, psychological, and social level using the Patient Evaluation Grid on the next page & the psychiatrist's notes below. What types of interventions/therapies would you employ? On what basis were these treatments selected? What are the expected outcomes? [Prioritize your interventions according to Mrs. S's immediate needs and longer-term goals. Indicate how you would tailor the intervention to her coping style & personality.]
You are the behavioral medicine psychologist brought in to formulate a behavioral diagnosis and biopsychosocial treatment plan for Mrs. J.S. Describe how psychological factors are affecting J.S's medical condition.
Excerpt from Psychiatrist's Report on J.S.'s Psychological Characteristics Patient was a tired-appearing woman who appeared slightly older than her stated age of 45. Complexion was shallow but without jaundice. There was moderate psychomotor retardation and some evident pain. She seemed somewhat anxious, but trying to compensate through an extremely compliant and cooperative manner and an overly pleasant affect. She was oriented x 3; cognition was unimpaired except for a digit span of 6f, 5 bw; there was excellent abstracting ability and judgment; insight appeared sound but incomplete. No psychotic thought processes or behavior were apparent. Mood seemed moderately depressed despite the pleasant effect; the patient denied any current or past wishes to die or to injure herself.
Spontaneous verbal content centered around the patient's detailed medical history; responses to questions were exceedingly explicit and logically explained. In many ways throughout the interview, the patient's rational capability and her stoic ability to cope with others' problems was underscored as a theme, e.g. her commuting by plane between California and Connecticut when her father was sick" (1978, when she herself was quite sick); her "helping her mother cope with agoraphobia," now that mother is widowed, and coaxing her to restaurants recently. Intellectualization and isolation of affect were prominent defenses and were especially notable as she spoke of the prognosis of the illness and her family's emotional response. Past use of counterphobic defenses may be inferred by the patient's career and intention of working with Hospice patients, although currently this is not prominent.
Although the patient reiterated several times that she wanted to control her pain non-pharmacologically, she would say almost in the same breath, "Maybe I just need someone to talk to. Maybe I need to be told to lower my expectations of myself." Now in the face of increasing physical disability and a probable untimely death, she hesitatingly presents for the first time to a psychiatrist for pain control. Within the environmental setting of her disabled mother, grown and growing children with lives of their own, and reserved husband who cannot bear the emotion of talking about her illness, however, it is difficult for her to admit to these needs and so "pain control" has represented for her both a real concern and an entry into psychotherapy; to her family, however, I am known strictly as her pain doctor. She has indicated that she would be very relieved if I could facilitate family communications so that she could talk more with her loved ones; but she warns that this could be a long and probably impossible task on my part.